The nanny-state lie behind Obamacare

A peculiarly American debate over the right to buy lousy stuff

U.S. Secretary of Health and Human Services Kathleen Sebelius appeared before a congressional hearing last week to apologize profusely for the problems affecting the Affordable Care Act website. (Jason Reed / Reuters)

About The Author

Neil MacdonaldSenior Correspondent

Neil Macdonald is a Senior Correspondent for CBC News, currently based in Ottawa. Prior to that he was the CBC's Washington correspondent for 12 years, and before that he spent five years reporting from the Middle East. He also had a previous career in newspapers, and speaks English and French fluently, and some Arabic.

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By far the most boring, if newsworthy, aspect of Obamacare's politically disastrous rollout is the U.S. government's malfunctioning website, HealthCare.gov.

It should surprise no one that a government can fumble and stagger when it tries a radical shift. And this time the change was a big one: harmonizing entire departments with private-sector computer systems (as opposed to penetrating them and stealing their data, which Washington is extremely good at, but that's a different issue).

I'm betting on the latter. The U.S. government has, after all, been collecting taxes for 150 years, and the IRS is still capable of losing your return and saying it's not the government's problem, even if you have proof of delivery. (Disclosure: Happened to me, twice.)

But the uproar over the website is obscuring what is probably the biggest reason for the blazingly divisive Obamacare fight.

Simply put, the question is whether the American government has the right to stop people from making stupid, self-destructive choices.

So Obama lied

Until now, the 15 million or so Americans who buy their own health insurance plans (as opposed to employer–provided benefits) have been at the mercy of the insurers, which are, after all, in the business of maximizing profits.

People who chose bargain plans would often find out at the worst moment just how worthless their plans were: The insurer would deploy a range of loopholes to minimize payout, or stick the patient with the entire bill.

In 2009, for example, Texas Republican Joe Barton told Congress about a constituent whose policy was cancelled just as she was about to undergo surgery for aggressive breast cancer.

A landing page on the not very well functioning Obamacare website. Long waits and error messages have bedevilled those who have been trying to sign up. (CBC)

The insurer, searching for a reason not to pay, had seized on a detail of her medical history. A doctor treating her earlier for acne had, wrongly it turned out, characterized it as possibly being a pre-cancerous skin condition. So the insurer refused to pay on the grounds that she had "a pre-existing condition."

Obamacare puts an end to that sort of scam by setting minimum standards for health-care coverage. As a result, millions of Americans have been notified that their plans are now legally substandard and are being cancelled.

The government says they can now find a better plan for less money (if the HealthCare.gov website ever comes back to life).

The trouble is, Barack Obama famously sold Obamacare by assuring Americans, repeatedly, that "if you like the plan you have, you can keep it. Period."

It was a politically expedient thing to say — health-care reform has failed in the past because people fear the government taking their coverage away. But it was nonetheless false, and the president almost certainly knew it.

The Washington Post's respected fact-checking section ranks his guarantee as a "four-Pinocchio" untruth.

Put less politely — which is exactly how Republicans are choosing to put it — the president lied, repeatedly, to the American people.

The right to buy crap

Obama and his Democrats are responding that these new rules are to protect people from "crappy" or "lousy" policies.

But this is America. A lot of people treasure their right to buy lousy crap.

"Why do you get to decide what's lousy?" Fox News's Megyn Kelly asked a Democratic member of Congress recently. "Why can't the American people say 'It's lousy for you. To me, I like it?'"

And there it is. The great American question. Should the government protect people, nanny-like, from their own bad judgment?

The conservative view here is no. Republicans despise anything they see as interfering with the free market, from industrial inspections to bank reforms to President Obama's Consumer Protection Bureau, with its powers to get between citizens and debt collectors, banks and credit card companies.

If someone wants to pay 30-per-cent-plus interest, basically for life, to a credit card company based in a state with no anti-usury laws, that's his or her right. No one's forcing them to borrow the money, right?

True believers

With Obamacare, though, the resentment goes deeper; even deeper, it seems, than the resentment many Americans feel about anything bearing this particular president's name.

The core premise of Obamacare is collective responsibility, a notion that underpins laws in most Western countries to one extent or another, but which is regarded with great suspicion by American conservatives.

Texas Senator Ted Cruz, one of the leading lights of the Tea Party movement within the Republican party, has been one of those leading the fight to dismantle the Democrat's health care plan. (Michael Ainsworth / Associated Press)

If you aren't over 65 and eligible for Medicare, or indigent and eligible for Medicaid, or if you don't have employer-provided medical insurance, you have to buy a plan, beginning when you're young and healthy.

The quid pro quo for the expanded customer base is supposed to be lower premiums (although so far, that hasn't worked in some states). Companies must also provide coverage to everyone, regardless of "pre-conditions," and can't concoct reasons not to pay.

This, to American conservatives, is socialism, even though the principles behind Obamacare are essentially a lift from earlier conservative thinking. But conservatives here have moved far to the right in recent years.

As today's U.S. conservatives see it, if you want to take the risk of not buying health-care coverage, and use the money to take the family to Dolly Parton's theme park in Nashville, that's your right.

As the libertarian Republican Ron Paul once said when confronted with the hypothetical question of what should be done with an uninsured patient who needs months of intensive care: "That's what freedom is all about, taking your own risks."

What that view ignores, of course, is that eventually, society has to pick up the cost when the uninsured get sick.

Either people lose their jobs and start collecting Medicaid, or they just turn up at the emergency wards and have no means of paying the bills.

In real-world America, hospitals are not permitted to withhold treatment for any reason, including lack of coverage or inability to pay. (Which is part of the reason for those wildly skewed fee schedules for those who do have insurance, to offset those who don't.)

In every civilized country, including this one, governments do, to a certain extent, protect society from the actions of individuals. Certain drugs require a prescription. Auto insurance is mandatory. As is mortgage insurance and deposit insurance.

In America, though, freedom is more a religion than a concept. And there's no arguing with true believers.

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